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Background: Advanced practice nursing (APN) roles offer improved access to care and increased quality and more timely care. Despite the advantages of APN roles, there is a disparity between European countries when it comes to implementing APN roles. Aim: To explore the implementation of APN roles in a range of European countries and to explore what factors facilitate or hinder the implementation of these roles. Methods: A case study evaluation of the process of implementing APN roles. The sample included four countries where APN roles were well developed (Ireland, Spain, Norway and the United Kingdom) and four where APN roles were implemented (Estonia, Slovenia, Cyprus and Romania). Interviews were conducted with key informants (n = 28) from government departments, regulatory bodies, nursing associations and universities. The consolidated criteria for reporting qualitative research (CPREQ) has been used throughout. Limitations: The small number of countries when considering the size of the region and key informants representing the view of only three to four people in each country. Results: Four themes were identified, including the rationale for the development of the roles, influence, the evolutionary nature of role development and evidence. The data also revealed a mismatch between the perceptions of how the roles develop among the different countries in the early stages of implementation. Conclusion: Successful role implementation is dependent upon a tripartite approach between managers, practitioners and educators. An evolutionary approach to role development was used. Regulation and policy come later on in the process of implementation. Implications for nursing policy: APN policy should be based on patient needs rather than on the workforce or professional imperatives. The process of implementation can take 15–20 years in total. Recognising the importance of the relationships between service managers and educators is key to the early development of these roles. [ABSTRACT FROM AUTHOR]

Background: Studies revealed unidirectional associations between frailty and medication‐related problems (MRPs) among older adults. Less is known about the association between frailty and the risk of MRPs. We aimed to assess the bi‐directional association between frailty and the risk of MRPs in community‐dwelling older adults in five European countries. Methods: Participants were 1785 older adults in the population‐based Urban Health Centres Europe project. Repeated assessments were collected at baseline and one‐year follow‐up, including frailty, the risk of MRPs, and covariates. Linear regression analyses were conducted to examine the unidirectional associations. A cross‐lagged panel modeling was used to assess bi‐directional associations. Results: The unidirectional association between frailty at baseline and the risk of MRPs at follow‐up remained statistically significant after adjusting for covariates (β = 0.10, 95%CI:0.08, 0.13). The association between the risk of MRPs at baseline and frailty at follow‐up shows similar trends. The bi‐directional association was comparable with reported unidirectional associations, with a stronger effect from frailty at baseline to the risk of MRPs at follow‐up than reversed path (Wald test for comparing lagged effects: p < 0.05). Conclusion: This longitudinal study suggests that a cycle may exist where older adults with higher frailty levels are more likely to have a higher risk of MRPs, which in turn contributes to developing a higher level of frailty. Further research is needed to validate our findings and explore underlying pathways. [ABSTRACT FROM AUTHOR]

Background: Health and social care systems face difficulties in managing multimorbidity, disease burden and complex needs in long‐term conditions such as Parkinson's disease. Objective: This study aimed to develop a European understanding of how health and social care professionals can collaborate with stakeholders from different organizations and sectors to enhance the management of Parkinson's disease in a community setting by identifying the existing gaps in this process and how people with Parkinson's disease and their family carers could benefit from these partnerships. Methods: A mixed‐methods sequential study was conducted in Denmark, Norway, Spain and the United Kingdom. The findings from the qualitative phase are presented. Individual semistructured interviews were analysed using Braun's and Clarke's thematic analysis. A meta‐ethnography approach was used to analyse and synthesize cross‐national findings. Results: A total of 41 healthcare professionals and 39 stakeholders from different disciplines and sectors were interviewed in the four countries. The participants acknowledged a lack of awareness of available resources and poor communication between the different support systems in the management of Parkinson's disease. To promote multiagency collaborations, the participants highlighted the need to organize services along the Parkinson's disease journey, patient involvement and strategic involvement of carers in organizing resources and Parkinson's disease care pathways. According to the participants, the benefits from multiagency partnerships could lead to an enhanced continuity of care and specialized knowledge, mobilization of resources in the community, personalized support and improved access to services. Conclusions: Policymakers are called upon to create formal structures that facilitate multisectoral collaborations to promote an integrated system of care for the management of Parkinson's disease in the community. To address this challenge, we propose five strategies showing how organizations can work together to optimize the use of resources and enhance the management of Parkinson's disease throughout the illness trajectory. Patient or Public Contribution: Patient and Public Involvement groups made up of stakeholders, healthcare professionals, patients with Parkinson's disease and family carers participated in the design of the study, the development of the interview guides and the validation of the findings. [ABSTRACT FROM AUTHOR]

Introduction: Chemsex in a European context is the use of any of the following drugs to facilitate sex: crystal methamphetamine, mephedrone and gamma‐hydroxybutyrate (GHB)/gamma‐butyrolactone (GBL) and, to a lesser extent, cocaine and ketamine. This study describes the prevalence of self‐reported recreational drug use and chemsex in HIV‐positive men who have sex with men (MSM) accessing HIV services in four countries. It also examines the problematic impacts and harms of chemsex and access to chemsex‐related services. Methods: This is a cross‐sectional multi‐centre questionnaire study of HIV‐positive MSM accessing nine HIV services in the UK, Spain, Greece and Italy. Results: In all, 1589 HIV‐positive MSM attending HIV services in four countries completed the questionnaire. The median age of participants was 38 years (interquartile range: 32–46 years) and 1525 (96.0%) were taking antiretroviral therapy (ART). In the previous 12 months, 709 (44.6%) had used recreational drugs, 382 (24.0%) reported chemsex and 104 (6.5%) reported injection of chemsex‐associated drugs ('slamsex'). Of the 382 engaging in chemsex, 155 (40.6%) reported unwanted side effects as a result of chemsex and 81 (21.2%) as a result of withdrawal from chemsex. The reported negative impacts from chemsex were on work (25.1%, 96), friends/family (24.3%, 93) and relationships (28.3%, 108). Fifty‐seven (14.9%) accessed chemsex‐related services in the past year, 38 of whom (67%) felt the service met their needs. Discussion: A quarter of participants self‐reported chemsex in the past 12 months. There were high rates of harms from chemsex across all countries, including negative impacts on work, friends/family and relationships. Although a minority of those engaging in chemsex accessed support, most found this useful. [ABSTRACT FROM AUTHOR]

Background: ‘Paediatric bipolar disorder’ (PBD) is a controversial diagnosis where often prepubertal children as well as adolescents, who may have a range of psychiatric disorders or symptoms, are diagnosed with a severe mental illness requiring lifelong medication. Clinically, it has often been applied in the United States but rarely in most other countries. A meta‐analysis (Van Meter et al., Journal of Clinical Psychiatry, , 72, 1250) claimed that the prevalence of PBD was similar to adults at 1.8% with no difference between the United States and other countries. This conclusion has been highly cited. Methods: The heterogeneous nature of the original 12 epidemiological surveys warrants a qualitative analysis, rather than statistical meta‐analysis as performed by Van Meter et al. (Journal of Clinical Psychiatry, 2011, 72, 1250). Thus, the meta‐analysis and each of the 12 studies (six from the United States; six from other countries) were reexamined. Results: Most of the 12 surveys predated the emergence of the PBD hypothesis. The 12 surveys were mainly of adolescents and at times young adults with few prepubertal children. Prevalence rates in the 12 studies suggest a lower rate of bipolar disorder, especially in non‐US samples. For example, the Van Meter et al. (Journal of Clinical Psychiatry, 2011, 72, 1250) meta‐analysis chose a rate of 2.8% by summation of adolescent and parent responses in a Dutch survey, however the rate fell to 0% if requiring concordance of adolescent and parent responses. Indeed, it could be argued that four of the non‐US studies show 0% rates of PBD. Conclusions: Rates of PBD were generally substantially lower than 1.8%, particularly in non‐US surveys, and if both parent and adolescent reports were required to meet the diagnostic threshold they fell to close to zero. The reanalysis suggests that bipolar disorder is rare before the expected age of onset in later adolescence. [ABSTRACT FROM AUTHOR]

How do individuals deal with group disadvantage when their fellow in-group members conceive it as legitimate? Integrating research on the normative conflict model (Packer, 2008, Pers. Soc. Psychol. Rev., 12, 50) and collective action, we expect high identifiers to reject the in-group norm of legitimacy that justifies the inequality, and to assert that the group is actually able and willing to contest the disadvantage by collective means. In Study 1 and Study 2, we tested this hypothesis in different intergroup contexts. The results confirmed our predictions and also showed one boundary condition for high identifiers, namely that the content of the social identity supports resistance. In Study 3, we found support for our hypothesis using artificial groups and manipulating identification experimentally. These results show that even when a disadvantaged group appears to accept its situation, high identified in-group members will still contest this and, moreover, expect other in-group members to support them in this endeavour. [ABSTRACT FROM AUTHOR]

Information about several topics discussed at the meeting of European Nutrition Foundations in Madrid on April 2010 is presented. Topics of the meeting include the nutrition in the school curriculum and regulations on foods and drinks provided in schools. The meeting features various executives including Juan Ballasteros.

Rates of peanut allergy in the Western world have increased over the last 30 years, although it is unclear why. While eating behaviours are likely to be connected to allergy prevalence, the precise relevant factors are uncertain. This study aimed to investigate dietary differences and changes in dietary habits in peanut consumption (in apparent and hidden forms) in four different countries (Bulgaria, Poland, Spain, UK), specifically chosen because of their different ‘peanut experiences’. Focus groups revealed a common perception that dietary habits have become less healthy, with more consumption of processed foods and an increase in snacking. In addition, ethnic cuisine was perceived to have had an important impact on European eating habits, while participants identified an increase in consumption of more ‘exotic’ forms of peanuts and their products. These findings point to an increase in exposure to peanuts, particularly in hidden forms, that superficially parallels increased prevalence rates. However, it was also clear that participants lacked knowledge about the composition of food and non-food products. The dietary trends identified here thus warrant further quantitative investigation, particularly in the context of differential national patterns of allergy prevalence – data on which is currently being gathered within the EC-funded EuroPrevall project. [ABSTRACT FROM AUTHOR]

Provides timely analysis of developments and prospects in the major economies. This includes a world overview, and detailed articles on the USA, Japan, the Eurozone, Germany, France, Italy, Spain, the UK and Emerging Markets. Summary tables of data for these economies are also included. [ABSTRACT FROM AUTHOR]

The article comments on the article "British Armaments and European Industrialization, 1890-1914: The Spanish Case Re-Examined," by R.J. Harrison. Harrison's article examined the economic and political conditions in Spain from 1890 to 1914. It is discusses the industrialization of European countries and how Great Britain was imbibed on building armaments. The article also considers Spain's working population that is engaged in agriculture during the period. It explores the scandal involving the Spanish naval program of the government of Antonio Maura. Official Assessor of the Naval Ministry, Juan Macias, accused the whole government of prevarication in the adjudication of tenders for the squadron.

Background and Aims: Non-alcoholic steatohepatitis (NASH) is a chronic disease that can progress to end-stage liver disease (ESLD). A large proportion of early-stage NASH patients remain undiagnosed compared to those with advanced fibrosis, who are more likely to receive disease management interventions. This study estimated the disease burden and economic impact of diagnosed NASH in the adult population of France, Germany, Italy, Spain and the United Kingdom in 2018., Methods: The socioeconomic burden of diagnosed NASH was estimated using cost-of-illness methodology applying a prevalence approach to estimate the number of adults with NASH and the attributable economic and wellbeing costs. Given undiagnosed patients do not incur costs in the study, the probability of diagnosis is central to cost estimation. The analysis was based on a literature review, databases and consultation with clinical experts, economists and patient groups., Results: The proportion of adult NASH patients with a diagnosis ranged from 11.9% to 12.7% across countries, which increased to 38.8%-39.1% for advanced fibrosis (F3-F4 compensated cirrhosis). Total economic costs were €8548-19 546M. Of these, health system costs were €619-1292M. Total wellbeing costs were €41 536-90 379M. The majority of the undiagnosed population (87.3%-88.2% of total prevalence) was found to have early-stage NASH, which, left untreated, may progress to more resource consuming ESLD over time., Conclusions: This study found that the majority of economic and wellbeing costs of NASH are experienced in late disease stages. Earlier diagnosis and care of NASH patients could reduce future healthcare costs., (© 2021 The Authors. Liver International published by John Wiley & Sons Ltd.)

The aim was to determine whether commercial baby foods marketed within Europe (up to 36 months of age) have inappropriate formulation and high sugar content and to provide suggestions to update European regulations and recommendations as part of a nutrient profile model developed for this age group. The latter was produced following recommended World Health Organization (WHO) steps, including undertaking a rapid literature review. Packaging information from countries across the WHO European region was used to determine mean energy from total sugar by food category. The percentage of products containing added sugar and the percentage of savoury meal-type products containing pureed fruit were also calculated. A total of 2,634 baby foods from 10 countries were summarised: 768 sold in the United Kingdom, over 200 each from Denmark (319), Spain (241), Italy (430) and Malta (243) and between 99-200 from Hungary, Norway, Portugal, Estonia and Slovenia. On average, approximately a third of energy in baby foods in these European countries came from total sugar, and for most food categories, energy from sugar was higher than 10%. Use of added sugars was widespread across product categories, with concentrated fruit juice most commonly used. Savoury meal-type purees did not contain added sugars except in United Kingdom and Malta; however, fruit as an ingredient was found in 7% of savoury meals, most frequently seen in UK products. Clear proposals for reducing the high sugar content seen in commercial baby foods were produced. These suggestions, relating to both content and labelling, should be used to update regulations and promote product reformulation., (© 2020 The Authors. Maternal & Child Nutrition published by John Wiley & Sons Ltd.)

Aim: The European Network of Excellence for Paediatric Clinical Research, known as the TEDDY Network, carried out a survey to determine the capacity and competence of paediatric centres to perform research studies., Methods: A cross-sectional, web-based pilot survey was conducted from October 2016 to April 2017 with paediatric clinical research centres in 11 countries: Albania, Austria, Belgium, Denmark, Iceland, Ireland, Italy, Norway, Spain, Switzerland and the United Kingdom. All were registered with the TEDDY Network database., Results: We approached 107 centres and 63 provided data on their experiences and expertise in paediatric clinical trials. Four groups of performance indicators were identified, referring to scientific experience, trial readiness, trial competence, regulatory issues, ethics and patients. Most centres were actively involved in paediatric clinical research: 53 centres (84.1%) had received funds for more than five paediatric studies in the last 5 years, and 42 (66.7%) had a specific clinical trial unit and dedicated study coordinators. We concluded that the European centres we studied had the capability and capacity to conduct paediatric trials, but there was still room for improvement, including enhanced collaboration., Conclusion: This pilot survey demonstrated that there is potential for performing paediatric trials across Europe, but improvements are possible., (© 2019 Foundation Acta Paediatrica. Published by John Wiley & Sons Ltd.)

The article focuses on the effects of immigration on the epidemiology of HIV transmission from mother to child in Western Europe. It discusses the Spanish NENEXP cohort study of mother to child HIV transmission in Catalonia, Spain, antiretroviral therapy (ART), and the effects of good antenatal care services.